Rondonotti Emanuele, Spada Cristiano, Cave David, Pennazio Marco, Riccioni Maria E, De Vitis Italo, Schneider David, Sprujevnik Tatiana, Villa Federica, Langelier Jennifer, Arrigoni Arrigo, Costamagna Guido, de Franchis Roberto
Department of Medical Sciences, University of Milan and Gastroenterology and GI Endoscopy Unit, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy.
Am J Gastroenterol. 2007 Aug;102(8):1624-31. doi: 10.1111/j.1572-0241.2007.01238.x. Epub 2007 Apr 24.
Duodenal biopsy is the current gold standard for diagnosis of celiac disease. Videocapsule endoscopy examines the entire small bowel and allows visualization of mucosal villi. We evaluated the potential of videocapsule endoscopy in assessing the severity and extent of mucosal changes in patients with suspected celiac disease.
Consecutive patients with signs/symptoms suggesting celiac disease and positive anti-gliadin and/or anti-endomysial and/or anti-tissue transglutaminase antibodies underwent upper gastrointestinal endoscopy and videocapsule endoscopy. Duodenal biopsies were classified according to modified Marsh's criteria. Capsule findings were evaluated for the presence of lesions compatible with celiac disease (scalloping of duodenal folds, fissures, flat mucosa, and mosaic appearance).
Forty-three patients were studied. Duodenal histology was normal in 11 and compatible with celiac disease in 32. Using duodenal histology as the gold standard, the performance characteristics of capsule endoscopy for the diagnosis of celiac disease were: sensitivity 87.5% (95% CI 76.1-98.9%), specificity 90.9% (95% CI 81.0-100%), positive predictive value 96.5% (95% CI 90.1-100%), negative predictive value 71.4% (95% CI 55.8-87%), positive and negative likelihood ratios 9.6 and 0.14, respectively. Eighteen patients had mucosal changes extending beyond the duodenum, involving the entire small bowel in three. These patients tended to have more severe symptoms, but the difference was not statistically significant. Interobserver agreement for the diagnosis of celiac disease by capsule endoscopy ranged between 79.2 and 94.4%; kappa values ranged between 0.56 and 0.87.
Videocapsule endoscopy shows good sensitivity and excellent specificity for the detection of villous atrophy in patients with suspected celiac disease.
十二指肠活检是目前诊断乳糜泻的金标准。视频胶囊内镜可检查整个小肠，并能观察黏膜绒毛。我们评估了视频胶囊内镜在评估疑似乳糜泻患者黏膜变化的严重程度和范围方面的潜力。
对有提示乳糜泻的体征/症状且抗麦胶蛋白和/或抗肌内膜和/或抗组织转谷氨酰胺酶抗体呈阳性的连续患者进行上消化道内镜检查和视频胶囊内镜检查。十二指肠活检根据改良的马什标准进行分类。评估胶囊检查结果中是否存在与乳糜泻相符的病变（十二指肠皱襞扇贝样改变、裂隙、黏膜平坦及马赛克样外观）。
共研究了43例患者。11例十二指肠组织学正常，32例符合乳糜泻。以十二指肠组织学作为金标准，胶囊内镜诊断乳糜泻的性能特征为：敏感性87.5%（95%可信区间76.1 - 98.9%），特异性90.9%（95%可信区间81.0 - 100%），阳性预测值96.5%（95%可信区间90.1 - 100%），阴性预测值71.4%（95%可信区间55.8 - 87%），阳性似然比和阴性似然比分别为9.6和0.14。18例患者的黏膜改变超出十二指肠，其中3例累及整个小肠。这些患者往往症状更严重，但差异无统计学意义。观察者之间对胶囊内镜诊断乳糜泻的一致性介于79.2%至94.4%之间；kappa值介于0.56至0.87之间。
视频胶囊内镜对疑似乳糜泻患者绒毛萎缩的检测具有良好的敏感性和出色的特异性。
